Iwata Hitoshi, Tsuzuki Seiichiro, Iwata Mitsunaga, Terasawa Teruhiko
Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Japan.
Intern Med. 2017 Oct 1;56(19):2671-2675. doi: 10.2169/internalmedicine.8689-16. Epub 2017 Sep 6.
Strict restriction of carbohydrates can induce symptomatic ketoacidosis. We herein report a 76-year-old demented woman who developed ketoacidosis after 1 month of abnormal eating behavior involving selectively eating hamburger steak (estimated carbohydrate =12.7 g/day). Laboratory tests showed high-anion-gap metabolic acidosis with elevated blood ketone levels. She was successfully treated with intravenous fluids followed by oral intake of a regular diet. She remained relapse-free after correcting her eating habits. Healthcare providers should know that abnormal eating behavior in demented people can lead to an extremely-low-carbohydrate diet and cause atypical ketoacidosis unexplained by diabetes, heavy alcohol intake, or starvation conditions.
严格限制碳水化合物摄入可诱发症状性酮症酸中毒。我们在此报告一名76岁的痴呆女性，她在出现选择性进食汉堡排（估计碳水化合物摄入量为12.7克/天）的异常饮食行为1个月后发生了酮症酸中毒。实验室检查显示高阴离子间隙代谢性酸中毒，血酮水平升高。她通过静脉补液治疗成功，随后恢复正常饮食。在纠正饮食习惯后，她未再复发。医疗保健人员应了解，痴呆患者的异常饮食行为可能导致极低碳水化合物饮食，并引发非糖尿病、大量饮酒或饥饿状态所无法解释的非典型酮症酸中毒。
